The Official Medtipster Blog

www.Medtipster.com Source: Los Angeles Times, 5.28.2010

Senior citizens who hit the so-called doughnut hole in Medicare’s drug benefit will begin getting $250 rebate checks in two weeks, the Obama administration announced Thursday — providing one of the first tangible benefits of the recently enacted healthcare law.

The rebates, designed in part to bolster support for the controversial law, are the first steps in a decade-long phase-out of the unpopular gap in Medicare Part D drug coverage.

Seniors now enrolled in a Medicare Part D plan pay 25% of the cost of their prescription drugs until the total bill reaches $2,830. At that point, enrollees must pay the full cost of their prescriptions until their total out-of-pocket spending reaches $4,550. Catastrophic coverage then kicks in and enrollees pay 5% of drug costs for the rest of the year.

Department of Health and Human Services officials said Thursday that the first 80,000 seniors who hit that coverage gap, or “doughnut hole,” will be sent checks on June 10, five days before the deadline.

Checks will then go out monthly until the end of the year as more seniors fall into the gap. Health and Human Services Secretary Kathleen Sebelius said Thursday that the department estimated slightly more than 4 million seniors would ultimately get rebates.

“Seniors do not have to do anything to get this check. They don’t have to sign anything. They don’t have to apply for it,” Sebelius said, warning recipients not to be fooled by scam artists seeking personal information by claiming it is necessary to process rebates.

Starting in 2011, the rebate will be replaced by a discount. Seniors whose expenses fall within the doughnut hole will qualify for a 50% discount on drugs. That will be gradually phased up to a 75% discount in 2020, effectively eliminating the coverage gap.

Thursday’s announcement comes as the Obama administration works to highlight benefits of the new healthcare law in the face of persistent public wariness.

Since President Obama signed the law in March, administration officials have secured commitments from insurance companies to immediately begin offering parents who buy their own insurance the option of including their adult children under 26. Employers who provide coverage may choose to make the option available, but it is not mandatory until October.

The administration is also working with states to create new high-risk pools this summer to allow people who have been denied coverage because of preexisting medical conditions to get insurance. However, there are questions about whether there is enough money to do this.

The new healthcare law’s biggest changes — including the creation of regulated insurance markets, the requirement that everyone have health insurance, and the ban on insurance companies denying coverage to sick people — do not go into effect until 2014.

www.Medtipster.com Source: FDAnews.com – Washington Drug Letter, 5.25.2010

AARP: Generic Drug Prices Drop, Brand Prices Continue Rising

The prices of brand-name prescription drugs most often used by Medicare beneficiaries increased nearly 10 percent over the 12-month period ending in March, an AARP report says.

While generic drug prices fell during the April 2009 to March 2010 period, the average price of top brand drugs used by Medicare beneficiaries rose 9.7 percent, continuing an upward trend in annual drug price increases, according to the AARP Public Policy Institute Rx Watchdog Report released last week.

Prices of generic drugs most widely used by Medicare beneficiaries dropped 9.7 percent while prices for widely used specialty drugs rose by 9.2 percent.
“These trends resulted in an average annual rate of increase of 5.3 percent for manufacturer drug prices during the 12 months ending with the first quarter of 2010 despite an extremely low rate of general inflation for all consumer goods and services,” the report says.

Drug companies raised the price of about two-thirds (90 of 144) of specialty drugs studied in the one-year period. Two of the 144 specialty drugs had a drop in price, and both were generics. For an individual taking one specialty medication, the average annual increase in cost of therapy rose by $2,760 during the study period.

AARP’s analysis echoes that of pharmacy benefit managerExpress Scripts’ 2009 Drug Trend Report, released last month. Prices of drugs in the most popular therapeutic classes increased 9.1 percent in 2009, according to that report.

PhRMA, however, said the AARP report is misleading and based on incomplete information. The report fails to take into account discounts and rebates generally negotiated between drug manufacturers and payers, which can significantly lower the cost of brand-name medicines, ultimately benefiting patients, Senior Vice President Ken Johnson said.

“Also, the report’s conclusions ignore the reality that prescription medicines represent a small and decreasing share of growth in overall health care costs in the United States,” Johnson said. “Not only is the current rate of growth for prescription medicines historically low, but the recent decline in drug spending growth has contributed to the lowest rate of total health care growth in almost 50 years.”

www.Medtipster.com source: www.timesunion.com – Cathleen F. Crowley, 5.19.2010

www.Medtipster.com Source: Chicago Tribune, 5.12.2010 – Whitney Woodward, Alejandra Cancino and Julie Deardorff

Martha Jimenez was worried when the antibiotic she was giving her 8-year-old daughter, Linda, ran out a day early.

“I got scared,” said Jimenez, who usually sees a doctor who speaks Spanish but made an emergency appointment because her daughter had a fever and bad nosebleeds. Jimenez left the doctor’s office without really understanding how to administer the medicine, and relied on the directions the pharmacist attached. But they were confusing, and Jimenez couldn’t figure out the dosage, so she guessed.

A study released recently suggests that similar miscommunications are not uncommon. Pharmacies that print prescription labels translated into Spanish often issue inaccurate or confusing instructions that could be potentially hazardous to a patient’s health, according to a report in the May issue of Pediatrics journal.

Researchers looked at 76 medicine labels generated by 13 different computer programs that many pharmacies use to make translations and found an overall error rate of 50 percent.

“It’s not surprising, and it’s something I experience in practice every day,” said Dr. Alejandro Clavier, who works at Esperanza Health Center in Chicago’s Little Village neighborhood on the Southwest Side.

He gave an example of an anemic patient who showed no signs of improved iron levels after taking prescribed supplements. Clavier discovered the patient had been taking only one drop of the supplements instead of the amount that Clavier had prescribed. The patient had received confusing prescription instructions from the pharmacy.

Prescription information delivered in “Spanglish,” a mix of English and Spanish, is a frequent problem, according to the study. For example, instructions to take iron “once” a day would mean one time. But in Spanish, once means 11. It could be harmful for a patient to take 11 doses of iron a day, the study noted.

Misspellings also created errors. The study found that instead of the word boca, which means “mouth” in Spanish, poca, which means “little,” was used.

Other words and phrases — including “dropperfuls,” “take with food,” “apply topically,” “for 7 days” and “apply to affected areas” — were not translated into Spanish at all.

“It’s scary how high the error rate is,” said lead author Dr. Iman Sharif, chief of the division of general pediatrics at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del. “If we can’t do this right in Spanish — the most commonly spoken non-English language in the U.S. — I’m afraid to think what happens with the other languages.”

Sharif’s report, which surveyed pharmacies in the Bronx, N.Y., goes hand-in-hand with the findings of a study last year from Northwestern University’s Feinberg School of Medicine. According to that study, many pharmacies in four states with large or rapidly growing Latino populations cannot provide prescription translations. That 2009 study also found that almost 35 percent of pharmacies surveyed did not offer translation services, and about 22 percent offered only limited translation services.

“It’s not that pharmacists are horrible people, it’s just that if they don’t speak the language … they don’t want to guess,” said Stacy Cooper Bailey, a clinical research associate at the Feinberg School of Medicine who was the lead researcher of the study. “They can’t do any spot checks for accuracy, so you can understand why there’d be some hesitancy there to do translations.”

During her research, one pharmacy employee said he would “run to the Mexican restaurant down the street” if a translation was needed, Bailey said. Others employed pharmacy staff members who had taken Spanish in high school, Bailey said.

The Alivio Medical Center in Chicago’s Pilsen neighborhood provides its 21,000 patients — the majority of whom speak Spanish — with services in Spanish and English. The center’s executive director, Carmen Velasquez, said using computers to translate important medical information is an inappropriate substitute for a human being.

“It’s health care. If you have the responsibility of human life, you better well know what you are doing and saying,” Velasquez said.

Sharif, the study’s author, said that one of the biggest problems is that English prescription instructions aren’t standardized. Because the same instructions can be written in multiple ways, the available databases can’t translate every word that doctors use to write prescription instructions, she said.

That’s why doctors and pharmacists must go over the instructions with patients and explain what they need to do, regardless of what language they speak, Sharif said.

That’s what Akil Ghoghawala does. The pharmacist manager of Bienestar Pharmacy, which operates inside the Alivio Medical Center, speaks five languages, including Spanish, and says he makes it a point to orally explain to patients how to take medications.

“It doesn’t only apply to someone who has a language barrier — it applies to everybody,” he said. But he has seen some bad translations, including ones that are verbatim. That leads to mistakes, he said.

“I override (the program), each and every time,” Ghoghawala said, adding that it is not a new problem.

Jimenez, 35, is thankful there was no serious injury to her daughter, but she still is not sure what went wrong. Back at Esperanza Health Center recently — this time for her 16-year-old son, Erick, who had a bad cough — she said she’ll make sure she understands the directions before she leaves the doctor’s office.

“If I don’t understand, I look for someone who speaks Spanish,” she said, or have her 14-year-old daughter translate.

www.Medtipster.com Source: NPR Health Blog – Scott Hensley, 5.6.2010

If you’ve rooted around your medicine chest and found some of the kids’ Tylenol, Motrin, Benadryl or Zyrtec recalled by Johnson & Johnson, what should you do?

The company’s McNeil unit says it will give you a refund, but you have to fill out a form online. Oh, and you also have to be available for a chat, in case a company rep wants to call and verify the info.

The New York Times’ Ron Lieber ripped J&J for not being better prepared and for not telling people sooner that refunds would be an option. The early advice was just to toss the stuff out.

On a listserv for families in our D.C. suburb, one helpful mom said she’d had good luck with the local CVS drugstore, which would even take back the affected medicines without a receipt.

We called CVS HQ in Rhode Island, where spokesman Mike DeAngelis told us the chain would, as is its usual policy, give cash refunds if a customer has a receipt. Without one, you get store credit in the form of a CVS gift card.

What if some of the medicine has been used? Doesn’t matter, he said. Bring in what you’ve got. So far, he said, the returns haven’t been all that heavy. CVS has already cleared its shelves of the affected medicines, and the computerized cash registers won’t let you buy any either.

We emailed rival chain Walgreens, but haven’t heard back yet. The company did post a letter it got from McNeil on what to do with the recalled remedies, though.

Update: OK, we just talked to Robert Elfinger, a spokesman for Walgreens, and you can take your recalled meds back to them for a refund, too.

“Bring the bottle back to the store, whether it’s full, or halfway full,” he just told us. “We’ll take it back and give the customer store credit.” If you’ve got the receipt, Walgreens will give you cash.

Locate a CVS Pharmacy or Walgreens closest to your home on Medtipster.com

Medtipster is pleased to publish an article from it’s first guest author. Thank you Deborah!

www.Medtipster.com Source: Deborah H. Land, www.cholesterolloweringdiets.net

a. The Myth of Good and Bad Cholesterol   

For some people, cholesterol is bad because they do not know there are two types of it. These two types are LDL and HDL – the bad cholesterol is called LDL, while the good one is called HDL. Plaques can form on one’s arteries if you have a lot of LDL in the bloodstream. Eventually, your arteries will get narrow as a result of being clogged up and it will block off blood flow. The truth is, your high cholesterol is not caused by dietary cholesterol but by other things. This is caused by excessive amounts of Tran’s fat and saturated fat. Exercise and eating a lot of fiber and unsaturated fats will do a lot to keep cholesterol down.

 b. What Numbers Mean in Cholesterol

 Every adult should have their cholesterol checked at least every 5 years. When you get a cholesterol test, you’ll usually get back four different results. Here are the 4 categories and the healthy range you want to be in.

Total Cholesterol – less than 200 mg/dL (5.2 mmol/L)

LDL Cholesterol – less than 100 mg/dL (2.6 mmol/L)

HDL Cholesterol – greater than 40 mg/dL (1.0 mmol/L)

Triglycerides – less than 150 mg/dL (1.7 mmol/L)

If you are over or under the desired level on any category, it is usually indicative that a diet or exercise change is needed.

c. Vitamin E and How it Can Protect the Heart

 Vitamin E is an important vitamin found in leafy vegetables, nuts, and vegetable oils. It was previously believed that a Vitamin E supplement could reduce the risk of heart disease, but several studies in the last few years have shown that this supplement does little to prevent heart attacks or strokes.

 d. Five Fabulous Foods to Decrease Cholesterol Levels

 1. Oatmeal and Oat Bran: These contain a high amount of soluble fiber, which can lower LDL.

2. Fish: Fish is a great source of omega 3 fatty acids, which lowers LDL and raises HDL.

3. Nuts: Not only are nuts high in fiber, but they contain the healthy fats you need to keep LDL in check.

4. Plant Sterols: This is found in foods like margarine, salad dressing, orange juice, and functional cookies. 2 grams per day will lower your LDL by 10-15%.

5. Soy: This popular meat replacement can lower LDL by up to 3%.

e. Health Benefits of Plant Sterols 

Plant sterols can be found in foods such as Benecol Spread, granola bars, VitaTops Muffin Tops and fat free milk. To help your heart, you should eat a lot of plant sterols-packed food and stop eating foods with saturated fat. You should know that this does not balance out a diet rich in saturated fats. To be in control of your cholesterol, you should still eat healthy and exercise often.

About the Author – Deborah H. Land writes for the cholesterol diet tips  blog (www.cholesterolloweringdiets.net), her personal hobby website she uses to help people eat healthy to lower bad cholesterol levels.

www.Medtipster.com Source: The Plain Dealer – May 6, 2010; www.cleveland.com

Your next trip to Giant Eagle for milk and eggs could include a visit with a University Hospitals nurse to get that scratchy throat checked out.

University Hospitals’ first FastCare clinic, opening inside the Legacy Village Giant Eagle on Thursday morning, will be staffed with UH nurse practitioners who can diagnose and treat basic ailments ranging from strep throat to bladder infections.

It will also be the region’s 19th example of what has become a growing national trend: drug stores, discounters and supermarkets opening limited-scope, walk-in clinics under their roofs.

But unlike some of its competitors, the UH FastCare will be staffed and controlled entirely by University Hospitals’ medical staff, with computers connected directly to the hospitals’ network, and treatment overseen by UH physicians.

“When you come into the University Hospitals FastCare clinic, you’re signing in as a UH patient,” said Dr. Michael Nochomovitz, president of University Hospitals Physician Services.

If someone comes in with something more serious, she would be sent to an urgent care center or to the hospital.

Future clinics will open inside Giant Eagle stores in Chardon, South Euclid, Stow, Wadsworth and Willoughby. The Stow and Wadsworth clinics will be staffed by Summa Health System nurse practitioners.

“People who have been in car accidents or who are having chest pains still need to go to the emergency room,” said Carol Kercher, one of three nurse practitioners who will be working out of Legacy Village.

But in the vast number of cases, complaints are minor (fevers, colds and flu, ear and sinus infections, bronchitis, pink eye and allergies) and can be treated on site for about $46 to $66 per visit.

No appointments are necessary, but if there’s a wait, patients will get a pager they like use at restaurants, said Jessica Kazarick, FastCare operations coordinator.

The idea is to offer a broader range of quality medical care to people who might not be able to see their own doctors, said Randy Heiser, Giant Eagle’s Pharmacy vice president. “We can also meet customers’ prescription needs if they choose our on-site Giant Eagle Pharmacy,” although patients can use any pharmacy.

Between last May and this May, the number of such clinics rose 5.2 percent, to 1,176 nationwide, according to Merchant Medicine LLC, a Minneapolis consulting company focused on urgent care and retail clinics.

Retailers like the fact that such clinics bring people into their stores and boost their pharmacy business, while hospitals like the fact that they ease overcrowding in emergency rooms and give the hospitals more referrals to their own doctors, said Merchant Medicine CEO Tom Charland. The fact that FastCare is run directly by University Hospitals means “if a patient shows up and the nurse practitioner notices that he hasn’t had a certain type of vaccine, she can give it to him right there and then update his chart,” he added.

Whereas if a third party is running the clinic, she would have to fax or e-mail the chart to the patient’s doctor.

Moreover, according to the Annals of Internal Medicine, “not only are retail clinics less expensive than urgent care centers, doctor’s offices and emergency rooms, but the quality of care is as good,” Charland said.

Giant Eagle proposed the partnership, and UH agreed because it’s the largest supermarket chain in Northeast Ohio, with 94 stores (84 with pharmacies inside).

Other retailers with in-store clinics include:

— Last year, the Cleveland Clinic announced a deal with CVS Caremark Corp., the nation’s largest drug store chain, to oversee nine MinuteClinics inside CVS/Pharmacies in Northeast Ohio.

Unlike UH FastCare, MinuteClinics are run by MinuteClinic nurse practioners under the supervision of Cleveland Clinic physicians, and MinuteClinic staff do not have access to Clinic medical records.

The Cleveland Clinic also plans to announce additional CVS MinuteClinics in Florida.

— Discount Drug Mart, based in Medina, operates two Community Express Care Clinics in its stores in Olmsted Falls and Independence, and plans to open three more by the end of the year. The clinics are staffed by nurse practitioners from Parma General Hospital.

— Walgreen Co., the nation’s second-largest drug store chain, has six Take Care Clinics inside stores in Barberton, Cuyahoga Falls, Elyria, Lorain, Mentor and Solon. The clinics are staffed by nurse practitioners and physicians assistants from Take Care Consumer Solutions, a wholly owned subsidiary of Walgreen.

— Acme Fresh Market has two ExpressCare Health Clinics run by staff from Akron General Hospital at its stores in Akron and Stow.

— Walmart Stores has one clinic at its store in Wooster, owned and operated by Bloomington Medical Services, and plans to open more.

— Future FastCare clinics will open inside stores in Chardon, South Euclid, Wadsworth, Willoughby and Stow, although opening dates for haven’t been decided. The Wadsworth and Willoughby clinics will be staffed by Summa Health System nurses.

FastCare will be operated independently from Giant Eagle, meaning no one from Giant Eagle will have access to names or medical records, and you don’t have to be a Giant Eagle Advantage customer to stop by.

“And unfortunately, you’re not going to get fuelperks (gas discounts) in this clinic,” Kazarick joked.

Visit www.medtipster.com to locate a Giant Eagle or another retail clinic nearest you.

www.Medtipster.com Source: DrugStoreNews.com, 5.4.2010 – Allison Cerra

A Southern California supermarket chain is offering free prenatal vitamins to expectant mothers this month.

In line with Pregnancy Awareness Month, Stater Bros.’ said its Super Rx Pharmacy will offer prenatal vitamins to those with a doctor’s prescription. Quantities must be written for a thirty-day supply and not to exceed 30 tablets. The free prenatal vitamin program will feature the generic version of these well-known brands:

• Advanced Natal Care
• Natal Care Glosstabs
• Nata Tab Rx
• Natal Care Plus
• Prenavite
• Ultra Natal Care

This initiative is one of several Stater Bros. has offered its customers. The supermarket chain also offers a free antibiotic program and $4 generic prescription drug program.

“Stater Bros. remains committed to the health and well-being of our valued customers,” stated Jack Brown, Stater Bros. chairman and CEO.  “As the only supermarket chain in Southern California to offer this program free of charge, Stater Bros. is proud to promote the health of mothers-to-be while easing some of the economic burden that many of our valued customers are facing.”

Vist www.Medtipster.com to locate the Stater Bros. Pharmacy nearest you offering free prenatal vitamins.

www.Medtipster.com Source: Wall Street Journal, May 3, 2010

Consumer complaints about certain over-the-counter children’s medications spurred an investigation that led to a recall of more than 40 different products because of manufacturing problems, according to officials at a unit of Johnson & Johnson.

The recall, announced over the weekend by the company and the U.S. Food and Drug Administration, prompted drug stores and other merchants to pull the medicines off their shelves and caused concern among parents who took steps to avoid giving the products — largely pain and allergy remedies — to their children.

A spokesman for J&J’s McNeil Consumer Healthcare unit wasn’t more specific about what issues consumers raised that led to the internal probe.

“We always receive some consumer inquiries about our products and those inquiries led to the investigation that ultimately led to this recall,” the spokesman, Marc Boston, said.

The company said there haven’t been any serious side effects reported, and the company and the FDA said the potential for harm is remote. Still, the company and the agency said the products shouldn’t be given to children for precautionary reasons.

The recall involved at least 1,000 lots of products, including pediatric versions of Tylenol, Motrin, Zyrtec and Benadryl.

Some of the liquid formulations may contain a higher concentration of their active ingredient than they should while others may contain inactive ingredients at inappropriate levels, or tiny metallic particles that are a residue of the manufacturing process, the company said.

The medicines were sold in the U.S. and Canada as well as in countries as far away as Fiji and Kuwait. All were made at a factory in Fort Washington, Pa., the FDA and the company said. Neither the company nor the FDA could say how many bottles of medicine were involved.

At English Drug, an independent pharmacy in Bethel, Conn., staffers removed several products from the store’s shelves Sunday morning after learning about the recall on the Internet. “These are very popular products, but we pulled them” out of safety concerns for consumers, said Denise McMahon, a pharmacist at the store.

In New York City, Natalia Carin said she recently gave her 2-year-old son Cole children’s Zyrtec and Motrin. He appears to be fine, she said, but added, “I’d like some information about what kind of substance this was and how dangerous it might be and what we can expect.”

Kenneth Polin, a pediatrician at Town and Country Pediatrics, with offices in Chicago and its suburbs, had heard from few worried parents Sunday, but says his advice is to turn to generic versions of the medicines. He recommended that before consumers buy a generic, they make sure to ask a pharmacist whether J&J manufactured it.

The recall is another dent in J&J’s reputation as a model of corporate responsiveness. That harks back to the deadly Tylenol poisonings in the early 1980s, when the company reacted swiftly to recall the product and inform the public.

More recently U.S. regulators have criticized J&J’s handling of product-quality issues, because of a widening series of recalls of over-the-counter medicines that accelerated late last year.

In November, the company recalled a limited number of certain bottles of Tylenol arthritis-pain caplets after identifying an uncharacteristic smell or taste associated with the products.

In December, J&J had to expand the recall to include all lots of the product. A month later, J&J widened the recall again to include other brands such as Motrin and Benadryl.

That resulted in the FDA sending J&J a warning letter saying the company had violated good-manufacturing rules at its Las Piedras, Puerto Rico, plant.